Hierarchical adaptive closed-loop fluid resuscitation and cardiovascular drug administration system

Abstract

The present disclosure describes a closed-loop fluid resuscitation and/or cardiovascular drug administration system that uses continuous measurements and adaptive control architecture. The adaptive control architecture uses a function approximator to identify unknown dynamics and physiological parameters of a patient to compute appropriate infusion rates and to regulate the endpoint of resuscitation.

The invention claimed is: 
     
       1. A closed loop system for fluid resuscitation or drug administration comprising:
 a) a processing module comprising computer-executable instructions stored on a non-transitory computer-readable storage medium configured to receive sensor-obtained hemodynamic measurements of a subject from a hemodynamic monitoring device; 
 b) at least one lower-level controller, wherein the at least one lower-level controller comprises:
 (i) a dynamic observer comprising a set of dynamic observer states for estimating a current value of one or more physiological parameters of the subject; and 
 (ii) a dynamical system using a function approximator comprising a set of basis functions and a set of weights to approximate at least one unknown function describing distribution of a fluid and/or drug in the body of the subject, 
 
 wherein the at least one lower-level controller is configured to compute infusion rates based at least upon the sensor-obtained hemodynamic measurements of the subject and the set of weights; 
 c) at least one higher-level logic-based controller communicatively coupled to the at least one lower-level controller, configured to:
 a. verify whether infusion rates of the at least one lower-level controller meet infusion rate requirements; 
 b. determine timing of engaging with the at least one lower-level controller; and 
 c. determine timing of disengaging the at least one lower-level controller based on violation of a performance criterion; 
 
 d) a user interface configured to:
 d. display computed infusion rates; 
 e. receive an initial infusion rate from an end-user; 
 f. communicate an initial infusion rate by the end-user to the at least one higher-level logic-based controller; and 
 g. notify the end-user if the performance criterion is violated. 
 
 
     
     
       2. The system of  claim 1 , wherein the function approximator is a neural network with sigmoidal basis functions. 
     
     
       3. The system of  claim 1 , wherein at least one element of the set of weights is reset to a new value if the infusion rate falls outside a user-specified safe range. 
     
     
       4. The system of  claim 1 , wherein the at least one lower-level controller has an internal dynamical system model that adapts to a dynamical system model of the subject. 
     
     
       5. The system of  claim 1 , wherein the criterion for the disengagement of the at least one lower-level controller is determined by comparing a set threshold with the difference between the hemodynamic measurements of the subject and target hemodynamic data in a set time interval. 
     
     
       6. The system of  claim 1 , further comprising a second lower-level controller, wherein the first lower level controller is initially engaged through the at least one higher-level logic-based controller; and wherein the at least one higher-level logic-based controller engages the second lower-level controller when at least one performance criterion is violated. 
     
     
       7. The system of  claim 1 , wherein the sensor-obtained hemodynamic measurement comprises the subject's blood pressure, heart rate, stroke volume variation, urine output rate, urine output, central venous pressure, pulse pressure variation, dynamic arterial elastance, systolic pressure variation, mean arterial pressure, systolic pressure, diastolic pressure, cardiac output, cardiac index, systemic vascular resistance or stroke volume. 
     
     
       8. The system of  claim 1 , further comprising an infusion pump communicatively coupled with the at least one higher-level logic-based controller for administering a fluid and/or a drug.